LIVER-TRANSPLANTATION FOR SMALL HEPATOCELLULAR-CARCINOMA - THE TUMOR-NODE-METASTASIS CLASSIFICATION DOES NOT HAVE PROGNOSTIC POWER

Tumoral recurrence rate and survival of patients with hepatocellular c arcinoma (HCC) treated by orthotopic liver transplantation (OLT) depen d on tumor stage. Thereby, from the beginning of our program, we selec ted only patients with solitary tumors less than or equal to 5 cm with out vascular invasion, thus avoiding the use of the tumor-node-metasta sis (TNM) staging system as a selection tool. The present study report s the results obtained in 58 consecutive patients (52 +/- 8 years, 47 males) with HCC (7 incidentals) transplanted between 1989 and 1995, Tr ansplantation was indicated because of tumor diagnosis in 40 cases and advanced liver failure in 18. Mean tumor size at staging was 28.2 +/- 12.1 mm. No adjuvant treatment was applied during the waiting period (58.9 +/- 45.1 days). The pathological tumor-node-metastasis (pTNM) cl assification allocated 15 patients to stage I, 19 to stage II, 11 to s tage IIIA, and 13 to stage IVA showing preoperative understaging in 43 % of the cases with known tumor. After a median follow up of 31 months , only two patients have shown tumor recurrence and fifteen have died, the 1-, 3-, and 5-year survival being 84%, 74%, and 74%. All HCV+ pat ients remain infected and 94% showed significant liver disease (6 cirr hosis). Six patients have had a second transplant. In conclusion, the application of restrictive criteria not following the TNM staging syst em prompts excellent results for liver transplantation in patients wit h HCC, both in terms of survival and disease recurrence, even without applying adjuvant treatment; however, the survival data should be temp ered by the appearance of complications that may worsen the long-term prognosis.